Provider Demographics
NPI:1235547217
Name:RICO, MARIA REFUGIO (CADTP REGISTERED)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:REFUGIO
Last Name:RICO
Suffix:
Gender:F
Credentials:CADTP REGISTERED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W BEAMER ST
Mailing Address - Street 2:WEST SIDE ENTRANCE
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-2510
Mailing Address - Country:US
Mailing Address - Phone:530-405-2815
Mailing Address - Fax:530-204-5255
Practice Address - Street 1:2403 PROFESSIONAL DR STE 101
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3007
Practice Address - Country:US
Practice Address - Phone:707-544-3295
Practice Address - Fax:707-544-9011
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)